Review article
Early esophageal squamous cell carcinoma management through endoscopic submucosal dissection
Manejo del carcinoma de células escamosas de esófago precoces a través de la disección endoscópica submucosa
V. Arantesa,
, J. Espinoza-Ríosb
Corresponding author
arantesvitor@ufmg.br
Corresponding author. Rua Florália 18, apt. 1201, Bairro Anchieta, Belo Horizonte, MG, Brazil. ZIP: 30310-690. Phone: +55(31) 99617 3441.
Corresponding author. Rua Florália 18, apt. 1201, Bairro Anchieta, Belo Horizonte, MG, Brazil. ZIP: 30310-690. Phone: +55(31) 99617 3441.
a Unidad de Endoscopia, Instituto Alfa de Gastroenterología, Facultad de Medicina de la Universidad Federal de Minas Gerais, Unidad de Endoscopia, Hospital Mater Dei Contorno, Belo Horizonte, Minas Gerais, Brazil
b Servicio de Gastroenterología, Hospital Cayetano Heredia, Facultad de Medicina «Alberto Hurtado», Universidad Peruana Cayetano Heredia, Lima, Peru
Read
12188
Timeswas read the article
3647
Total PDF
8541
Total HTML
Share statistics
array:24 [ "pii" => "S2255534X18300525" "issn" => "2255534X" "doi" => "10.1016/j.rgmxen.2018.05.004" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "439" "copyrightAnyo" => "2018" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "ssu" "cita" => "Rev Gastroenterol Mex. 2018;83:259-67" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1799 "formatos" => array:3 [ "EPUB" => 184 "HTML" => 1117 "PDF" => 498 ] ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S0375090618300363" "issn" => "03750906" "doi" => "10.1016/j.rgmx.2017.12.004" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "439" "copyright" => "Asociación Mexicana de Gastroenterología" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "ssu" "cita" => "Rev Gastroenterol Mex. 2018;83:259-67" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3225 "formatos" => array:3 [ "EPUB" => 277 "HTML" => 2096 "PDF" => 852 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Cartas Científicas</span>" "titulo" => "Manejo del carcinoma de células escamosas de esófago precoces a través de la disección endoscópica submucosa" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "259" "paginaFinal" => "267" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Early esophageal squamous cell carcinoma management through endoscopic submucosal dissection" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 780 "Ancho" => 950 "Tamanyo" => 131457 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Cromoendoscopia signo del color salmón luego de 3 min.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "V. Arantes, J. Espinoza-Ríos" "autores" => array:2 [ 0 => array:2 [ "nombre" => "V." "apellidos" => "Arantes" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Espinoza-Ríos" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2255534X18300525" "doi" => "10.1016/j.rgmxen.2018.05.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2255534X18300525?idApp=UINPBA000046" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0375090618300363?idApp=UINPBA000046" "url" => "/03750906/0000008300000003/v1_201807150538/S0375090618300363/v1_201807150538/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2255534X18300562" "issn" => "2255534X" "doi" => "10.1016/j.rgmxen.2018.05.008" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "453" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "ssu" "cita" => "Rev Gastroenterol Mex. 2018;83:268-74" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1990 "formatos" => array:3 [ "EPUB" => 162 "HTML" => 1361 "PDF" => 467 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>" "titulo" => "Overlap between functional abdominal pain disorders and organic diseases in children" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "268" "paginaFinal" => "274" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sobreposición entre los trastornos funcionales de dolor abdominal y enfermedades orgánicas en niños" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A.H. Langshaw, J.M. Rosen, L. Pensabene, O. Borrelli, S. Salvatore, N. Thapar, D. Concolino, M. Saps" "autores" => array:8 [ 0 => array:2 [ "nombre" => "A.H." "apellidos" => "Langshaw" ] 1 => array:2 [ "nombre" => "J.M." "apellidos" => "Rosen" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Pensabene" ] 3 => array:2 [ "nombre" => "O." "apellidos" => "Borrelli" ] 4 => array:2 [ "nombre" => "S." "apellidos" => "Salvatore" ] 5 => array:2 [ "nombre" => "N." "apellidos" => "Thapar" ] 6 => array:2 [ "nombre" => "D." "apellidos" => "Concolino" ] 7 => array:2 [ "nombre" => "M." "apellidos" => "Saps" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0375090618300521" "doi" => "10.1016/j.rgmx.2018.02.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0375090618300521?idApp=UINPBA000046" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2255534X18300562?idApp=UINPBA000046" "url" => "/2255534X/0000008300000003/v1_201808030432/S2255534X18300562/v1_201808030432/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2255534X18300288" "issn" => "2255534X" "doi" => "10.1016/j.rgmxen.2017.09.002" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "429" "copyright" => "Asociación Mexicana de Gastroenterología" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Gastroenterol Mex. 2018;83:253-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1518 "formatos" => array:3 [ "EPUB" => 174 "HTML" => 838 "PDF" => 506 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Frequency of human papillomavirus infection in patients with gastrointestinal cancer" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "253" "paginaFinal" => "258" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Frecuencia de infección por virus del papiloma humano en pacientes con cáncer del aparato digestivo" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F. Roesch-Dietlen, A.D. Cano-Contreras, Y.J. Sánchez-Maza, J.M. Espinosa-González, M.Á. Vázquez-Prieto, E.J. Valdés-de la O, F. Díaz-Roesch, M.Á. Carrasco-Arroniz, A. Cruz-Palacios, P. Grube-Pagola, A. Sumoza-Toledo, H. Vivanco-Cid, G. Mellado-Sánchez, A. Meixueiro-Daza, C.S. Silva-Cañetas, M.G. Carrillo-Toledo, R. Lagunes-Torres, M. Amieva-Balmori, P.C. Gómez-Castaño, J.U. Reyes-Huerta, J.M. Remes-Troche" "autores" => array:21 [ 0 => array:2 [ "nombre" => "F." "apellidos" => "Roesch-Dietlen" ] 1 => array:2 [ "nombre" => "A.D." "apellidos" => "Cano-Contreras" ] 2 => array:2 [ "nombre" => "Y.J." "apellidos" => "Sánchez-Maza" ] 3 => array:2 [ "nombre" => "J.M." "apellidos" => "Espinosa-González" ] 4 => array:2 [ "nombre" => "M.Á." "apellidos" => "Vázquez-Prieto" ] 5 => array:2 [ "nombre" => "E.J." "apellidos" => "Valdés-de la O" ] 6 => array:2 [ "nombre" => "F." "apellidos" => "Díaz-Roesch" ] 7 => array:2 [ "nombre" => "M.Á." "apellidos" => "Carrasco-Arroniz" ] 8 => array:2 [ "nombre" => "A." "apellidos" => "Cruz-Palacios" ] 9 => array:2 [ "nombre" => "P." "apellidos" => "Grube-Pagola" ] 10 => array:2 [ "nombre" => "A." "apellidos" => "Sumoza-Toledo" ] 11 => array:2 [ "nombre" => "H." "apellidos" => "Vivanco-Cid" ] 12 => array:2 [ "nombre" => "G." "apellidos" => "Mellado-Sánchez" ] 13 => array:2 [ "nombre" => "A." "apellidos" => "Meixueiro-Daza" ] 14 => array:2 [ "nombre" => "C.S." "apellidos" => "Silva-Cañetas" ] 15 => array:2 [ "nombre" => "M.G." "apellidos" => "Carrillo-Toledo" ] 16 => array:2 [ "nombre" => "R." "apellidos" => "Lagunes-Torres" ] 17 => array:2 [ "nombre" => "M." "apellidos" => "Amieva-Balmori" ] 18 => array:2 [ "nombre" => "P.C." "apellidos" => "Gómez-Castaño" ] 19 => array:2 [ "nombre" => "J.U." "apellidos" => "Reyes-Huerta" ] 20 => array:2 [ "nombre" => "J.M." "apellidos" => "Remes-Troche" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0375090618300259" "doi" => "10.1016/j.rgmx.2017.09.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0375090618300259?idApp=UINPBA000046" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2255534X18300288?idApp=UINPBA000046" "url" => "/2255534X/0000008300000003/v1_201808030432/S2255534X18300288/v1_201808030432/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>" "titulo" => "Early esophageal squamous cell carcinoma management through endoscopic submucosal dissection" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "259" "paginaFinal" => "267" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "V. Arantes, J. Espinoza-Ríos" "autores" => array:2 [ 0 => array:4 [ "nombre" => "V." "apellidos" => "Arantes" "email" => array:1 [ 0 => "arantesvitor@ufmg.br" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Espinoza-Ríos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Endoscopia, Instituto Alfa de Gastroenterología, Facultad de Medicina de la Universidad Federal de Minas Gerais, Unidad de Endoscopia, Hospital Mater Dei Contorno, Belo Horizonte, Minas Gerais, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Gastroenterología, Hospital Cayetano Heredia, Facultad de Medicina «Alberto Hurtado», Universidad Peruana Cayetano Heredia, Lima, Peru" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author. Rua Florália 18, apt. 1201, Bairro Anchieta, Belo Horizonte, MG, Brazil. ZIP: 30310-690. Phone: +55(31) 99617 3441." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Manejo del carcinoma de células escamosas de esófago precoces a través de la disección endoscópica submucosa" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 854 "Ancho" => 950 "Tamanyo" => 72984 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Marking.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Malignant tumor of the esophagus is the eighth most frequent cancer and the sixth cause of death worldwide. An estimated 450,000 new cases were diagnosed in 2012, along with close to 400,000 deaths attributed to that condition. Those figures are related to the presentation of symptoms at advanced stages of the disease and the consequent poor prognosis. Definitive cure is no longer an option at the advanced disease stage, underlining the necessity of early stage diagnosis.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">1–4</span></a> The incidence of esophageal cancer has increased worldwide. In the United States, there has been a 7-fold increase in incidence over the last 30 years, especially in white males. Mean 5-year survival for esophageal cancer has not improved and remains below 15%.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">1,3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">There are 2 primary neoplasias in the esophagus: squamous cell carcinoma (SCC) and adenocarcinoma. SCC is the most frequent type in Asia and the rest of the world and is associated with tobacco, alcohol abuse, nitrosamine use, caustic agent ingestion, achalasia, thermal injury due to hot drinks, tylosis, micronutrient deficiency (riboflavin, retinol, ascorbic acid, alpha-tocopherol, selenium, magnesium, and zinc). In turn, adenocarcinoma is frequent in Europe and North America and its risk factors are gastroesophageal reflux (Barrett's esophagus) and elevated body mass index.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">1,2,5–7</span></a> SCC of the esophagus is more frequent in men (3.6:1) between the fifth and seventh decades of life. In Brazil, the mortality rate is 14.3 men and 4.2 women for every 100,000 persons.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">8</span></a> Those two types of cancer differ in the metastatic lymphadenopathy rate, with a greater risk in patients with SCC, compared with patients with adenocarcinoma.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The development of new endoscopic techniques that include chromoendoscopy with Lugol's solution, narrow-band imaging (NBI), flexible spectral imaging color enhancement (FICE), magnification endoscopy, confocal microscopy, high-resolution endoscopy, and spectroscopy have augmented sensitivity and specificity in the early-stage detection of those types of neoplasias. That is important, because early diagnosis of SCC improves its outcome, with 5-year survival rates of up to 95%.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">3,4,8–11</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The treatment of choice for esophageal cancer has traditionally been surgical, even in early-stage disease. However, esophagectomy is associated with high morbidity and mortality rates.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">6</span></a> In the last two decades, endoscopic treatment that includes endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) has advanced, becoming a viable curative alternative to surgery in selected cases of early esophageal cancer. The advantages of endoscopic treatment are organ preservation, a practically null mortality rate, and low complication rates between 1-8% that include bleeding, perforation, and stricture. <a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">2,6,9,11</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">EMR was the first endoscopic therapy to be developed and has been used as treatment for superficial SCC. It is an effective therapy and less invasive than esophagectomy. However, that technique only removes small lesions <span class="elsevierStyleItalic">en bloc</span> (<10<span class="elsevierStyleHsp" style=""></span>mm). Larger lesions require piecemeal resection, which predisposes to imprecise histopathologic evaluation and is associated with increased rates of local recurrence.<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">2,4,10</span></a> The ESD technique was developed in Japan and proposes <span class="elsevierStyleItalic">en bloc</span> resection of lesions larger than 20<span class="elsevierStyleHsp" style=""></span>mm, reducing the need for piecemeal resection and enabling a precise evaluation of the resection margins (vertical and lateral), resulting in much lower local recurrence rates than with EMR and an excellent long-term cancer-free survival rate.<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">4,6,12–14</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The aim of the present article was to contribute to the understanding of recent advances in esophageal cancer management with a detailed review of the ESD technique in patients with SCC, diffusing information of that procedure so it can be incorporated into Western endoscopy centers, especially in Latin America. Because there are certain differences in the management of endoscopic treatment of SCC of the esophagus from that of adenocarcinoma and high-grade Barrett's esophagus, our review focused on the technical aspects related to the diagnosis and treatment of SCC of the esophagus.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Diagnosis</span><p id="par0035" class="elsevierStylePara elsevierViewall">Esophageal neoplasia classically presents with progressive dysphagia and weight loss. When there is chest pain, invasion into the mediastinum should be suspected, and if there is associated ulceration or proximal esophagitis, the patient can manifest odynophagia.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a> Tumors tend to be advanced in those cases, with no possibility of endoscopic curative treatment. Therefore, the first challenge is to establish diagnosis of esophageal cancer in its early stage, in other words, when the patient is asymptomatic and has subtle endoscopic changes that are difficult to recognize. Among such changes are a mucosa with pale or red epithelium and altered microvascular pattern with slight elevation or depression of its surface (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>).<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">1,8</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The best diagnostic method is endoscopy, and even better, when it is combined with chromoendoscopy. That technique improves detection, given that squamous dysplasia can be difficult to recognize through standard endoscopy.<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">2,8</span></a> Nevertheless, performing endoscopy on the general population as screening for SCC is not justifiable, due to the cost of the procedure, but it is cost-effective in the high-risk population, such as patients with squamous cell cancer of the head and neck.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">8</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Chromoendoscopy utilizing Lugol's solution is considered the method of choice for the diagnosis of SCC and has 96% sensitivity and 63% specificity, compared with conventional white light endoscopy, which has 62% sensitivity and 79% specificity (<a class="elsevierStyleCrossRef" href="#fig0010">fig. 2</a>)<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">2,8</span></a> Lugol's solution is a dye that reacts with squamous cells of the esophagus that have a high glycogen content. Thus, neoplastic or dysplastic cells do not have that reaction because of their poor glycogen storage. However, the “pink sign” should be evaluated. It consists of a change in the color of the neoplastic lesion from yellow to pink, 2 to 5<span class="elsevierStyleHsp" style=""></span>min after Lugol's solution application (<a class="elsevierStyleCrossRef" href="#fig0015">fig. 3</a>). The pink sign is highly specific for dysplasia or SCC.<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">4,8</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Nevertheless, Lugol's solution application involves greater time and costs and also has the adverse effects and complications of allergic reaction, chest pain, or solution aspiration. Currently, the new digital chromoendoscopy methods of FICE and NBI can reduce those adverse situations<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">15,16</span></a> (<a class="elsevierStyleCrossRef" href="#fig0020">fig. 4</a>). Arantes et al.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">15</span></a> conducted a study that utilized transnasal endoscopy as the esophageal SCC detection method in patients with squamous cell cancer of the head and neck, applying the diagnostic techniques of white light endoscopy and FICE and comparing them with the gold standard of Lugol's solution. They found that the first two methods were similar in SCC detection and had high sensitivity and specificity values. A systematic review and meta-analysis by Morita et al.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">16</span></a> was recently published on the diagnosis of high-grade dysplasia and SCC in the esophagus, comparing NBI and Lugol's solution. They found that both methods had the same detection rate. Thus, the new digital methods of chromoendoscopy are useful for adequate screening.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Endoscopic staging of early esophageal cancer</span><p id="par0055" class="elsevierStylePara elsevierViewall">Outcome and adequate selection of treatment for esophageal cancer is closely related to disease staging.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">7</span></a> Early esophageal cancer is defined as lesions whose morphologic aspect compromise the mucosal and submucosal layers, without infiltrating the muscularis propria.<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">7,9,17</span></a> Flat superficial neoplasias predominate in the esophagus and are subdivided in relation to the adjacent mucosa as superficially raised (IIA), flat (IIB), and depressed (IIC). Protruded and excavated forms, based on the Paris classification, are rare.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a> Superficial neoplasias are subdivided according to the degree of transmural penetration as follows: m1: corresponds to the epithelium and basal layer; m2: lamina propria; and m3: muscularis mucosae. If there is invasion into the submucosa, it is classified as sm1: upper third; sm2: middle third; and sm3: lower third. In the absence of invasion into the lamina propria, the lesion is denominated intraepithelial neoplasia with high-grade dysplasia and the term carcinoma in situ can be used, as described in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. <a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">2,7,17</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The classification described above aids in defining the risk for presenting with metastatic lymphadenopathy, given that they are closely related to the vertical depth or level of the lesion in the wall of the affected organ, which is a key factor in the selection of patients for successful curative endoscopic treatment. Thus, when tumor involvement is limited to the superficial epithelium (m1 and m2), the risk for metastatic lymphatic involvement is almost null and endoscopic treatment is sufficient for cure. But if the tumor invades the muscularis mucosae (m3) and the proximal portion of the submucosa at a depth less than 200<span class="elsevierStyleHsp" style=""></span>μm under the muscularis mucosae (sm1), the risk can reach 9 and 19%, respectively, especially if there is lymphatic or vascular invasion. Those cases are on the borderline of curative endoscopic treatment and therefore an integrated evaluation is essential for defining the following parameters: tumor size, lymphovascular invasion, and horizontal extension of the invasion into the muscularis mucosae, given that there is a high risk for metastatic lymphadenopathies in tumors that deeply invade the submucosa.<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">4,6,9,12,17,18</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Staging of esophageal cancer should begin with a thoracoabdominal computed tomography scan to evaluate distant metastasis. However, tomography has poor sensitivity for detecting celiac lymphadenopathies and small metastases (particularly peritoneal ones) and lesion depth cannot be defined. Endoscopic ultrasound enables a more accurate definition of the depth of invasion of the lesion and the presence of metastatic lymphadenopathies in the mediastinum or the celiac trunk, thus determining stages T1a and T1b with a sensitivity and specificity above 80%.<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">7,9,19</span></a> Patients with complete invasion of the submucosa or with regional or distant metastases determined through tomography or endoscopic ultrasound, should not undergo ESD.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Endoscopic treatment indications for early esophageal cancer</span><p id="par0070" class="elsevierStylePara elsevierViewall">The following are the criteria for curative endoscopic resection of early esophageal cancer:<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0075" class="elsevierStylePara elsevierViewall">Lesion depth restricted to stages m1 and m2 (basal layer and lamina propria).</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0080" class="elsevierStylePara elsevierViewall">Maximum length of 3<span class="elsevierStyleHsp" style=""></span>cm and lateral extension less than 3/4 of the circumference.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0085" class="elsevierStylePara elsevierViewall">Maximum of 4 lesions.</p></li></ul></p><p id="par0090" class="elsevierStylePara elsevierViewall">With the incorporation of ESD, lesions can be larger than 3<span class="elsevierStyleHsp" style=""></span>cm, even if they occupy the totality of the circumference, in addition to there being no limit as to the number lesions, as long as they are early neoplasias.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a> The Japan Esophageal Society defines the absolute indications for ESD in early SCC of the esophagus as: esophageal lesion limited to the epithelium (m1) or lamina propria (m2), but involving less than 2/3 of the circumference. Among the relative indications that should be considered for adding chemotherapy and radiotherapy are: lesion that invades the muscularis mucosae (m3) or submucosa (sm1), but with no lymphadenopathies or metastases prior to the ESD, and lesion limited to the epithelium (m1) or lamina propria (m2), involving more than 2/3 of the circumference of the esophagus.<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">4,6,17</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Endoscopic submucosal dissection of early esophageal cancer</span><p id="par0095" class="elsevierStylePara elsevierViewall">Endoscopic resection of the mucosa was developed at the end of the 1980s and was rapidly accepted as an alternative to surgery in the treatment of superficial esophageal neoplasia.<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">20,21</span></a> However, complete extraction was not possible in larger lesions (15<span class="elsevierStyleHsp" style=""></span>mm), and so piecemeal resection was developed for those types of tumor. There was a high rate of local recurrence with that technique, which was resolved with the development of the new endoscopic therapy of ESD.<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">2,6,19,20</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">ESD is an advanced endoscopic technique whose aim is to allow <span class="elsevierStyleItalic">en bloc</span> resection in lesions larger than 2<span class="elsevierStyleHsp" style=""></span>cm. It also covers the detection, diagnosis, treatment, and prevention and management of complications (bleeding, perforation, stricture) with long-term follow-up, and therefore requires adequate training. Despite the fact that the minimum number of cases needed to perform ESD of the esophagus is not defined, Japanese experts recommend carrying out at least 50 ESD procedures in the distal stomach or rectum, before performing it in the esophagus.<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">4,17,22,23</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">ESD was originally designed for application in the stomach, but was later applied in the esophagus, colon, and rectum. The wall of the esophagus measures 3.5-4<span class="elsevierStyleHsp" style=""></span>mm, increasing its technical difficulty, due to the reduced luminal space, compared with the stomach. However, despite that greater technical difficulty, ESD has been shown to be an effective and safe treatment for SCC of the esophagus, increasing patient survival rates.<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">7,17,19,22,24</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The wall of the digestive tract is made up of two main components: the mucosa and the muscularis mucosae. They both are separated by the submucosa (connective tissue), signifying that <span class="elsevierStyleItalic">en bloc</span> resection involves a risk for involuntary injury of the muscular layer, resulting in perforation of the viscera. To reduce that risk, the injection of a viscous solution of sodium hyaluronate, hydroxypropyl methylcellulose, sodium carboxymethylcellulose, hypertonic dextrose, hypertonic saline, fibrinogen, or glycerol is required to separate the early neoplasia from the muscularis propria.<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">7,12,17</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Esophageal endoscopic submucosal dissection technique</span><p id="par0115" class="elsevierStylePara elsevierViewall">The procedure is performed with the patient under deep sedation, generally with endotracheal intubation that facilitates better sedation and prevents the risk for aspiration. Prophylactic antibiotic use is controversial and not well-defined, even though different endoscopy centers in Japan use second-generation cephalosporins IV for 3 days.<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">4,17,20</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">After complete lesion evaluation utilizing magnification endoscopy and digital chromoendoscopy, chromoendoscopy with Lugol's solution at 0.8% should be carried out to adequately define the limits of the lesion (<a class="elsevierStyleCrossRef" href="#fig0010">fig. 2</a>).<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">4,17,19,24,25</span></a> The most widely recommended electrosurgical equipment is VIO 200D or 300D (Erbe Elektromedizin GmbH, Tu¿bingen, Germany). ESD can be performed using different types of endoknives: the Hook Knife (KD- 620LR, Olympus, Tokyo, Japan); the Dual Knife (KD- 650, Olympus, Tokyo, Japan); and the IT Knife (KD-612, Olympus, Tokyo, Japan), which is the most widely used in gastric ESD. However, it has a high perforation rate in ESD of the esophagus, leading to the recent development of the IT Knife nano (KD- 612, Olympus) for ESD of the colon and esophagus.<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">20</span></a> There is also the 1.5 mm-long short stylet needle: the Flush Knife (FK) (Fujifilm, Tokyo, Japan), which not only enables marking, incision, submucosal dissection, and hemostasis, but also makes the simultaneous injection of saline solution possible.<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">9,12,17,20,23</span></a> CO<span class="elsevierStyleInf">2</span> insufflation is indicated because it is absorbed more quickly than air and excreted during respiration, which is useful for preventing severe mediastinal emphysema, and in the case of perforation, it provides enough time for endoscopic closure with endoclip.<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">4,12,20</span></a> In the present review, we describe esophageal ESD utilizing the FK.</p><p id="par0125" class="elsevierStylePara elsevierViewall">After the chromoendoscopy, the limits of the lesion are marked with the FK with ERBE parameters: soft coagulation, effect 5, 100W, with a minimum distance from the lesion of 2<span class="elsevierStyleHsp" style=""></span>mm from the lateral margins and 5<span class="elsevierStyleHsp" style=""></span>mm from the proximal margins to reduce the risk of stricture caused by ESD (<a class="elsevierStyleCrossRef" href="#fig0025">fig. 5</a>).<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">4,17,20</span></a> Injection of the submucosa with saline solution is then carried out, which should be done at the oral margin of the lesion from one end to the other. First saline solution is injected, followed by an injection of 0.4% sodium hyaluronate solution (Muco-Up<span class="elsevierStyleSup">®</span>, Seikagaku, Japan), which keeps the lesion raised for a longer period of time.<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">4,12,17,26</span></a></p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">A transverse and lateral incision with the FK is then made, deep enough to reach the submucosal plane (parameters: Endocut I, effect 4, cut duration: 2, cut interval: 3) (<a class="elsevierStyleCrossRef" href="#fig0030">fig. 6</a>). In addition, the cap is used for presenting the submucosal tissue and the endoscopic submucosal dissection is carried out in the oral-anal direction, always parallel to the axis of the esophageal wall to prevent perforation risk (submucosal layer dissection parameters: forced coagulation, effect 2, 40<span class="elsevierStyleHsp" style=""></span>W) (<a class="elsevierStyleCrossRef" href="#fig0035">fig. 7</a>).<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">4,17,20</span></a> Every time electric dissection is performed, injection of saline solution at the level of the submucosa can be added.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a></p><elsevierMultimedia ident="fig0030"></elsevierMultimedia><elsevierMultimedia ident="fig0035"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">An important part of making the procedure safer is preventing bleeding during ESD and adequate hemostasis is essential. If a submucosal vessel is identified, or unexpected bleeding presents, hemostasis must be performed with the FK (parameters: soft coagulation, effect 5, 100<span class="elsevierStyleHsp" style=""></span>W) for 3 to 5 s on each side of the vessel, followed by forced coagulation.<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">12,17,20</span></a> If hemostasis cannot be controlled in 3 attempts, the COAG grasper (Olympus, Tokyo, Japan) hemostasis forceps should be used.<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">20,25</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Finally, the samples must be removed with a foreign body tweezer, trapped on the submucosal side to not damage the mucosal side of the lesion. The dissection site should be re-evaluated (<a class="elsevierStyleCrossRef" href="#fig0040">fig. 8</a>) if prominent vessels are observed and they should receive hemostasis. If there are muscular layer lacerations, therapy should be performed with an endoscopic clip. The sample is fixed with pins over a plate of expanded polystyrene (<span class="elsevierStyleItalic">tecnopor</span>) and placed in formalin (<a class="elsevierStyleCrossRef" href="#fig0045">fig. 9</a>). The pathologist should cut the sample into 2-cm-wide fragments that are parallel and perpendicular to the lesion and evaluate them according to the Vienna Classification, identifying: the size of the lesion, its differentiation grade, and its depth, along with the proximal, distal, lateral, and vertical margins.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">8,17,25</span></a> The depth of the invasion is measured in micrometers (μm) from the last layer of the muscularis mucosae, with a cutoff point of 200<span class="elsevierStyleHsp" style=""></span>μm for sm1.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">25</span></a></p><elsevierMultimedia ident="fig0040"></elsevierMultimedia><elsevierMultimedia ident="fig0045"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Post-esophageal endoscopic submucosal dissection</span><p id="par0145" class="elsevierStylePara elsevierViewall">The patient usually remains in a fasting state the first 24<span class="elsevierStyleHsp" style=""></span>h after ESD therapy, with oral sucralfate and 40<span class="elsevierStyleHsp" style=""></span>mg of a proton pump inhibitor (PPI) every 12<span class="elsevierStyleHsp" style=""></span>h. A progressive liquid diet can be initiated the next day.<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">4,19</span></a> Patients with gastroesophageal reflux should receive PPI therapy for 2 months after the procedure. Endoscopic control should be carried out 3 months after ESD, after which annual endoscopy that includes chromoendoscopy, should be performed to evaluate recurrence or metachronous lesions (<a class="elsevierStyleCrossRef" href="#fig0050">fig. 10</a>).<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">4</span></a></p><elsevierMultimedia ident="fig0050"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Esophageal endoscopic submucosal dissection complications</span><p id="par0150" class="elsevierStylePara elsevierViewall">Complication rates are low, at 0 to 4% for significant bleeding, defined as that above 500<span class="elsevierStyleHsp" style=""></span>ml or a fall in hemoglobin > 2<span class="elsevierStyleHsp" style=""></span>g/dl, and at 2.6-6.9% for perforation. The latter can cause mediastinal emphysema, which has been described as a complication in different published case series. Emphysema increases the mediastinal pressure, reducing the esophageal lumen, resulting in inadequate visualization of its mucosa. But severe mediastinal emphysema can also present, with the complication of developing pneumothorax, which can end in shock. Therefore, the patient should be monitored during the procedure through an electrocardiogram, oxygen saturation, capnography, blood pressure, and periodic cervical palpation to evaluate the presence of subcutaneous emphysema.<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">14,20,24,25</span></a> If there is perforation after ESD, it can be treated conservatively with endoclip placement, NPO, adequate hydration, and antibiotic therapy.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">4</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Stricture is the complication of greatest incidence, from 3 to 18%, after ESD of the esophagus. The extension of the resection is the most important predictor. If it is above 75% of its circumference, there is a higher probability of presenting with that event. Esophageal stricture is a factor that reduces patient quality of life and can require numerous balloon dilation sessions.<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">4,17,20,27</span></a> The efficacy of oral prednisone has been described for stricture prevention (<a class="elsevierStyleCrossRef" href="#fig0055">fig. 11</a>). In the Japanese study conducted by Kataoka et al.,<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">28</span></a> they compared 2 groups: one that received treatment with oral systemic steroids with an initial dose of 30<span class="elsevierStyleHsp" style=""></span>mg of prednisone that was gradually decreased each week, and the other that received no preventive treatment. The authors found that the stricture rate and the number of balloon dilation sessions were considerably lower in the group that received the corticoids, versus the group that did not, and the differences were statistically significant. Another option is the injection of 4<span class="elsevierStyleHsp" style=""></span>ml of triamcinolone acetate, 10<span class="elsevierStyleHsp" style=""></span>mg/ml through an injection catheter, carrying out 20 punctures of solution of 0.2<span class="elsevierStyleHsp" style=""></span>ml each, at the edge and the center of the resection.<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">4,17,20</span></a> Other options for the prevention of esophageal stricture after circumferential ESD include hydrostatic balloon dilation, the use of polyglycolic acid membranes, autotransplantation of gastroesophageal tissue, and the use of metal stents.<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">29</span></a></p><elsevierMultimedia ident="fig0055"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclusions</span><p id="par0160" class="elsevierStylePara elsevierViewall">ESD is the treatment of choice for early-stage SCC. It has a low recurrence rate and reduced morbidity and mortality. The greatest challenge is to have early diagnosis of esophageal cancer, and so screening and surveillance programs for high-risk patients are a priority. ESD is technically more difficult in the esophagus than in the stomach, due to its narrow lumen, and its safe and efficient performance requires adequately trained endoscopists. It is essential to develop training centers in Latin America for the professionals interested in learning ESD, a procedure that would offer great quality of life benefits to the patients in our communities that are candidates for its performance.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Financial disclosure</span><p id="par0165" class="elsevierStylePara elsevierViewall">No financial support was received in relation to this study/article.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflict of interest</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors declare that there is no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:16 [ 0 => array:3 [ "identificador" => "xres1067607" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1015108" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1067606" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1015109" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Diagnosis" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Endoscopic staging of early esophageal cancer" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Endoscopic treatment indications for early esophageal cancer" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Endoscopic submucosal dissection of early esophageal cancer" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Esophageal endoscopic submucosal dissection technique" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Post-esophageal endoscopic submucosal dissection" ] 11 => array:2 [ "identificador" => "sec0040" "titulo" => "Esophageal endoscopic submucosal dissection complications" ] 12 => array:2 [ "identificador" => "sec0045" "titulo" => "Conclusions" ] 13 => array:2 [ "identificador" => "sec0050" "titulo" => "Financial disclosure" ] 14 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflict of interest" ] 15 => array:1 [ "titulo" => "Références" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-06-16" "fechaAceptado" => "2017-12-01" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1015108" "palabras" => array:4 [ 0 => "Early esophageal cancer" 1 => "Squamous cell carcinoma" 2 => "Endoscopic submucosal dissection" 3 => "Endoscopic mucosal resection" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1015109" "palabras" => array:4 [ 0 => "Cáncer de esófago temprano" 1 => "Carcinoma de células escamosas" 2 => "Disección endoscópica submucosa" 3 => "Resección de mucosa endoscópica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The incidence of esophageal cancer is steadily increasing worldwide. Outcome is poor, given that the majority of cases are diagnosed at advanced disease stages. However, when detected at early stages, esophageal tumors can be curatively treated through less invasive methods, resulting in a 5-year survival rate above 90%. Therefore, it is essential to identify the high-risk population and recommend those patients undergo screening using high-resolution endoscopy, adding the resources of chromoendoscopy with Lugol solution (or digital chromoendoscopy) and magnification. Such systematized examination makes it possible to recognize early-stage esophageal neoplasia and propose endoscopic submucosal dissection as treatment. In that procedure, the tumor is resected <span class="elsevierStyleItalic">en bloc</span>, resulting in lower morbidity and mortality, compared with previous standard treatment, including early-stage esophagectomy. The present article is a review of the latest advances in the management of superficial esophageal tumors through endoscopic submucosal dissection.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La incidencia del cáncer de esófago viene aumentando progresivamente a nivel mundial. Su pronóstico es pobre ya que en su mayoría el diagnóstico se realiza en estadios avanzados. Sin embargo, cuando es detectado en estadio precoz, las neoplasias esofágicas pueden ser tratadas de forma curativa y por métodos menos invasivos, resultando en una sobrevida de más del 90% en 5 años. Por lo tanto, es clave identificar la población de alto riesgo del cáncer esofágico y recomendarles endoscopia de alta resolución de cribado, agregando recursos de cromoendoscopia con lugol (o digital) y magnificación. Este examen sistematizado permite reconocer la neoplasia esofágica en estadio temprano, donde se puede proponer tratamiento endoscópico mediante la disección endoscópica submucosa (DES) realizándose la resección en bloque de la lesión tumoral con disminución de la morbimortalidad en comparación con el tratamiento estándar previo, incluso en estadios tempranos como lo era la esofagectomía. El objetivo de este artículo es revisar los últimos avances en el manejo de las neoplasias esofágicas superficiales a través de la DES.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Arantes V, Espinoza-Ríos J. Manejo del carcinoma de células escamosas de esófago precoces a través de la disección endoscópica submucosa. Revista de Gastroenterología de México. 2018;83:259–267.</p>" ] ] "multimedia" => array:12 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 757 "Ancho" => 950 "Tamanyo" => 62433 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">White light endoscopy of the early esophageal lesion.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 788 "Ancho" => 950 "Tamanyo" => 112886 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Chromoendoscopy with Lugol's solution.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 780 "Ancho" => 950 "Tamanyo" => 131727 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Chromoendoscopy with the salmon sign after 3<span class="elsevierStyleHsp" style=""></span>minutes.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 809 "Ancho" => 950 "Tamanyo" => 95095 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Digital chromoendoscopy: FICE.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 854 "Ancho" => 950 "Tamanyo" => 72984 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Marking.</p>" ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 793 "Ancho" => 950 "Tamanyo" => 88777 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Incision of the mucosa.</p>" ] ] 6 => array:7 [ "identificador" => "fig0035" "etiqueta" => "Figure 7" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr7.jpeg" "Alto" => 799 "Ancho" => 950 "Tamanyo" => 86069 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Endoscopic dissection of the submucosa.</p>" ] ] 7 => array:7 [ "identificador" => "fig0040" "etiqueta" => "Figure 8" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr8.jpeg" "Alto" => 736 "Ancho" => 950 "Tamanyo" => 69000 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Esophagus after endoscopic dissection of the submucosa.</p>" ] ] 8 => array:7 [ "identificador" => "fig0045" "etiqueta" => "Figure 9" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr9.jpeg" "Alto" => 780 "Ancho" => 950 "Tamanyo" => 141793 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Tumor lesion with pins on the <span class="elsevierStyleItalic">tecnopor</span> plate.</p>" ] ] 9 => array:7 [ "identificador" => "fig0050" "etiqueta" => "Figure 10" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr10.jpeg" "Alto" => 806 "Ancho" => 950 "Tamanyo" => 71236 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Endoscopic control after ESD (30 days). Patient received prophylactic oral corticoid therapy for stricture for 4 weeks.</p>" ] ] 10 => array:7 [ "identificador" => "fig0055" "etiqueta" => "Figure 11" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr11.jpeg" "Alto" => 809 "Ancho" => 950 "Tamanyo" => 70857 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Endoscopic control at 90 days, with no stricture or residual lesion after corticoid therapy.</p>" ] ] 11 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Tis: Carcinoma in situ.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tx \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Primary tumor that cannot be defined \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No evidence of primary tumor \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tis, m1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">High-grade dysplasia, limited to the mucosal layer \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T1<br>T1, m2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tumor invades the lamina propria, muscularis mucosae, or submucosa T1a<br>Tumor invades the lamina propria \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T1, m3<br>T1, sm1<br>T1, sm2<br>T1, sm3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tumor invades the muscularis mucosae T1b<br>Tumor invades up to the upper third of the mucosa<br>Tumor invades up to the middle third of the submucosa<br>Tumor penetrates the lower third of the submucosa \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tumor invades the muscularis propria \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tumor invades the adventitia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T4<br>T4a<br>T4b \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tumor invades adjacent organs<br>A resectable tumor that invades the pleura, pericardium, or diaphragm<br>Unresectable tumor that invades the aorta, vertebra, trachea, or other adjacent organ \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1820868.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Definitions of category T for esophageal cancer.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Références" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:29 [ 0 => array:3 [ "identificador" => "bib0150" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Esophageal cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.R. Alsop" 1 => "P. Sharma" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Gastroenterol Clin N Am" "fecha" => "2016" "volumen" => "45" "paginaInicial" => "399" "paginaFinal" => "412" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0155" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Esophageal cancer: Risk factors, screening and endoscopic treatment in Western and Eastern countries" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.J. Domper Arnal" 1 => "Á. Ferrández Arenas" 2 => "Á. Lanas Arbeloa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3748/wjg.v21.i26.7933" "Revista" => array:7 [ "tituloSerie" => "World J Gastroenterol" "fecha" => "2015" "volumen" => "21" "paginaInicial" => "7933" "paginaFinal" => "7943" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26185366" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0735109715068400" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0160" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endoscopic assessment and management of early esophageal adenocarcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.M. Hammoud" 1 => "H. Hammad" 2 => "J.A. Ibdah" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4251/wjgo.v6.i8.275" "Revista" => array:6 [ "tituloSerie" => "World J Gastrointest Oncol" "fecha" => "2014" "volumen" => "6" "paginaInicial" => "275" "paginaFinal" => "288" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25132925" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0165" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endoscopic submucosal dissection for malignant esophageal lesions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H. Hammad" 1 => "T. Kaltenbach" 2 => "R. Soetikno" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11894-014-0386-0" "Revista" => array:5 [ "tituloSerie" => "Curr Gastroenterol Rep" "fecha" => "2014" "volumen" => "16" "paginaInicial" => "386" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24659252" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0170" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnostics and early diagnosis of esophageal cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V. Meves" 1 => "A. Behrens" 2 => "J. Pohl" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000439473" "Revista" => array:6 [ "tituloSerie" => "Viszeralmedizin" "fecha" => "2015" "volumen" => "31" "paginaInicial" => "315" "paginaFinal" => "318" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26989385" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0175" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endoscopic management of early esophagogastric cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "Q.U. Rizvi" 1 => "A. Balachandran" 2 => "D. Koay" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.soc.2016.10.007" "Revista" => array:6 [ "tituloSerie" => "Surg Oncol Clin N Am" "fecha" => "2017" "volumen" => "26" "paginaInicial" => "179" "paginaFinal" => "191" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28279463" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0180" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Advances in endoluminal therapy for esophageal cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.K. Enestvedt" 1 => "G.G. Ginsberg" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gastrointest Endoscopy Clin N Am" "fecha" => "2013" "volumen" => "23" "paginaInicial" => "17" "paginaFinal" => "39" "itemHostRev" => array:3 [ "pii" => "S0140673615608224" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0185" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Advances in the management of early esophageal carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "V. Arantes" 1 => "E.A. Forero Piñeros" 2 => "K. Yoshimura" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Col Bras Cir" "fecha" => "2012" "volumen" => "39" "paginaInicial" => "534" "paginaFinal" => "543" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23348652" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0190" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endoscopic approaches for early-stage esophageal cancer: Current options" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "V. Patel" 1 => "R.A. Burbridge" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11912-014-0421-1" "Revista" => array:5 [ "tituloSerie" => "Curr Oncol Rep" "fecha" => "2015" "volumen" => "17" "paginaInicial" => "421" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25416315" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0195" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endoscopic submucosal dissection vs. endoscopic mucosal resection for superficial esophageal cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H.M. Guo" 1 => "X.Q. Zhang" 2 => "M. Chen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3748/wjg.v20.i18.5540" "Revista" => array:7 [ "tituloSerie" => "World J Gastroenterol" "fecha" => "2014" "volumen" => "20" "paginaInicial" => "5540" "paginaFinal" => "5547" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24833885" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673615608224" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0200" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endoscopic management of early esophageal cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.A. Barnes" 1 => "F.F. Willingham" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MCG.0000000000000353" "Revista" => array:6 [ "tituloSerie" => "J Clin Gastroenterol" "fecha" => "2015" "volumen" => "49" "paginaInicial" => "638" "paginaFinal" => "646" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26125458" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0205" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endoscopic submucosal dissection-current success and future directions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H. Yamamoto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/nrgastro.2012.97" "Revista" => array:6 [ "tituloSerie" => "Nat Rev Gastroenterol Hepatol" "fecha" => "2012" "volumen" => "9" "paginaInicial" => "519" "paginaFinal" => "529" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22664591" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0210" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Disección submucosa endoscópica. Guía de práctica clínica de la SEED" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. Fernández-Esparrach" 1 => "Á. Calderón" 2 => "J. de la Peña" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Esp Enferm Dig." "fecha" => "2014" "volumen" => "106" "paginaInicial" => "120" "paginaFinal" => "132" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24852737" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0215" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Initial experience of endoscopic submucosal dissection in Brazil to treat early gastric and esophagheal cancer: A multi-institutional analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D.M. Chaves" 1 => "E.G. Moura" 2 => "D. Milhomem" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arq Gastroenterol" "fecha" => "2013" "volumen" => "50" "paginaInicial" => "148" "paginaFinal" => "152" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23903626" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0220" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effectiveness of unsedated transnasal endoscopy with white-light, flexible spectral imaging color enhancement, and lugol staining for esophageal cancer screening in high-risk patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "V. Arantes" 1 => "W. Albuquerque" 2 => "J.M. Salles" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MCG.0b013e3182617fc1" "Revista" => array:6 [ "tituloSerie" => "J Clin Gastroenterol" "fecha" => "2013" "volumen" => "47" "paginaInicial" => "314" "paginaFinal" => "321" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23059405" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0225" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Narrow band imaging versus lugol chromoendoscopy to diagnose squamous cell carcinoma of the esophagus: A systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F.H. Morita" 1 => "W.M. Bernardo" 2 => "I de E" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12885-016-3011-9" "Revista" => array:6 [ "tituloSerie" => "BMC Cancer" "fecha" => "2017" "volumen" => "17" "paginaInicial" => "54" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28086818" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1885585716302778" "estado" => "S300" "issn" => "18855857" ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0230" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Disección endoscópica de submucosa en el tratamiento del cáncer precoz de esófago" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "V. Arantes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Med Clin Condes" "fecha" => "2015" "volumen" => "26" "paginaInicial" => "565" "paginaFinal" => "571" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0235" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endoscopic submucosal dissection of early esophageal cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T. Oyama" 1 => "A. Tomori" 2 => "K. Hotta" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Clinical Gastroenterology and Hepatology" "fecha" => "2005" "volumen" => "3" "numero" => "7 Suppl 1" "paginaInicial" => "S67" "paginaFinal" => "S70" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16013002" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0240" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endoscopic submucosal dissection for early esophageal neoplasia: A single center experience in South Taiwan" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C.T. Lee" 1 => "C.Y. Chang" 2 => "C.M. Tai" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jfma.2010.12.002" "Revista" => array:6 [ "tituloSerie" => "J Formos Med Assoc." "fecha" => "2012" "volumen" => "111" "paginaInicial" => "132" "paginaFinal" => "139" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22423666" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0245" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Esophageal ESD technique and prevention of complications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "T. Oyama" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Gastrointest Endoscopy Clin N Am" "fecha" => "2014" "volumen" => "24" "paginaInicial" => "201" "paginaFinal" => "212" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0250" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of endoscopic therapies and surgical resection in patients with early esophageal cancer: a population-based study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Wani" 1 => "J. Drahos" 2 => "M.B. Cook" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.gie.2013.08.002" "Revista" => array:7 [ "tituloSerie" => "Gastrointest Endosc" "fecha" => "2014" "volumen" => "79" "paginaInicial" => "224" "paginaFinal" => "232" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24060519" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1885585713003794" "estado" => "S300" "issn" => "18855857" ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0255" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Learning endoscopic resection in the esophagus" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F.G. Van Vilsteren" 1 => "R.E. Pouw" 2 => "L. Alvarez Herrero" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-0034-1392558" "Revista" => array:6 [ "tituloSerie" => "Endoscopy" "fecha" => "2015" "volumen" => "47" "paginaInicial" => "972" "paginaFinal" => "979" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26361090" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0260" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Disección endoscópica de la submucosa" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M.A. Tanimoto" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Gastroenterol Mex." "fecha" => "2010" "volumen" => "2" "paginaInicial" => "177" "paginaFinal" => "185" ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0265" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Standardized endoscopic submucosal tunnel dissection for management of early esophageal tumors (with video)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "V. Arantes" 1 => "W. Albuquerque" 2 => "C.A. Freitas Dias" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.gie.2013.05.031" "Revista" => array:6 [ "tituloSerie" => "Gastrointest Endosc" "fecha" => "2013" "volumen" => "78" "paginaInicial" => "946" "paginaFinal" => "952" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23810327" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0270" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A phase II study of endoscopic submucosal dissection for superficial esophageal neoplasms" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "K. Higuchi" 1 => "S. Tanabe" 2 => "M. Azuma" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.gie.2013.04.182" "Revista" => array:6 [ "tituloSerie" => "Gastrointest Endosc" "fecha" => "2013" "volumen" => "78" "paginaInicial" => "704" "paginaFinal" => "710" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23680178" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0275" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The performance of a novel ball-tipped Flush knife for endoscopic submucosal dissection: A case-control study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T. Toyonaga" 1 => "Man-I.M." 2 => "Fujita T." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Aliment Pharmacol Ther" "fecha" => "2010" "volumen" => "32" "paginaInicial" => "908" "paginaFinal" => "915" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20839389" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1885585715004569" "estado" => "S300" "issn" => "18855857" ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0280" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictors of postoperative stricture after esophageal endoscopic submucosal dissection for superficial squamous cell neoplasms" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Ono" 1 => "M. Fujishiro" 2 => "K. Niimi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-0029-1214867" "Revista" => array:6 [ "tituloSerie" => "Endoscopy" "fecha" => "2009" "volumen" => "41" "paginaInicial" => "661" "paginaFinal" => "665" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19565442" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0285" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy of short period, low dose oral prednisolone for the prevention of stricture after circumferential endoscopic submucosal dissection (ESD) for esophageal cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Kataoka" 1 => "S. Anzai" 2 => "T. Shirasaki" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Endosc Int Open" "fecha" => "2015" "volumen" => "3" "paginaInicial" => "113" "paginaFinal" => "117" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0290" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevention of esophageal strictures after endoscopic submucosal dissection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Kobayashi" 1 => "N. Kanai" 2 => "T. Ohki" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3748/wjg.v20.i41.15098" "Revista" => array:7 [ "tituloSerie" => "World J Gastroenterol" "fecha" => "2014" "volumen" => "20" "paginaInicial" => "15098" "paginaFinal" => "15109" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25386058" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0735109717393166" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/2255534X/0000008300000003/v1_201808030432/S2255534X18300525/v1_201808030432/en/main.assets" "Apartado" => array:4 [ "identificador" => "23966" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Review Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/2255534X/0000008300000003/v1_201808030432/S2255534X18300525/v1_201808030432/en/main.pdf?idApp=UINPBA000046&text.app=https://www.revistagastroenterologiamexico.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2255534X18300525?idApp=UINPBA000046" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 30 | 11 | 41 |
| 2024 September | 115 | 26 | 141 |
| 2024 August | 63 | 13 | 76 |
| 2024 July | 86 | 45 | 131 |
| 2024 June | 98 | 40 | 138 |
| 2024 May | 92 | 45 | 137 |
| 2024 April | 119 | 37 | 156 |
| 2024 March | 107 | 48 | 155 |
| 2024 February | 105 | 39 | 144 |
| 2024 January | 90 | 41 | 131 |
| 2023 December | 81 | 56 | 137 |
| 2023 November | 108 | 51 | 159 |
| 2023 October | 202 | 45 | 247 |
| 2023 September | 203 | 84 | 287 |
| 2023 August | 69 | 29 | 98 |
| 2023 July | 105 | 35 | 140 |
| 2023 June | 123 | 43 | 166 |
| 2023 May | 140 | 33 | 173 |
| 2023 April | 107 | 23 | 130 |
| 2023 March | 249 | 45 | 294 |
| 2023 February | 199 | 34 | 233 |
| 2023 January | 147 | 37 | 184 |
| 2022 December | 225 | 57 | 282 |
| 2022 November | 189 | 77 | 266 |
| 2022 October | 230 | 59 | 289 |
| 2022 September | 124 | 65 | 189 |
| 2022 August | 188 | 64 | 252 |
| 2022 July | 144 | 59 | 203 |
| 2022 June | 135 | 54 | 189 |
| 2022 May | 154 | 70 | 224 |
| 2022 April | 229 | 93 | 322 |
| 2022 March | 240 | 128 | 368 |
| 2022 February | 246 | 92 | 338 |
| 2022 January | 186 | 95 | 281 |
| 2021 December | 107 | 84 | 191 |
| 2021 November | 102 | 83 | 185 |
| 2021 October | 148 | 131 | 279 |
| 2021 September | 130 | 99 | 229 |
| 2021 August | 143 | 104 | 247 |
| 2021 July | 205 | 83 | 288 |
| 2021 June | 172 | 85 | 257 |
| 2021 May | 132 | 85 | 217 |
| 2021 April | 268 | 152 | 420 |
| 2021 March | 156 | 62 | 218 |
| 2021 February | 107 | 42 | 149 |
| 2021 January | 80 | 47 | 127 |
| 2020 December | 93 | 23 | 116 |
| 2020 November | 79 | 38 | 117 |
| 2020 October | 88 | 38 | 126 |
| 2020 September | 83 | 37 | 120 |
| 2020 August | 83 | 35 | 118 |
| 2020 July | 44 | 30 | 74 |
| 2020 June | 67 | 30 | 97 |
| 2020 May | 82 | 33 | 115 |
| 2020 April | 48 | 22 | 70 |
| 2020 March | 53 | 21 | 74 |
| 2020 February | 74 | 31 | 105 |
| 2020 January | 51 | 14 | 65 |
| 2019 December | 69 | 26 | 95 |
| 2019 November | 57 | 33 | 90 |
| 2019 October | 39 | 18 | 57 |
| 2019 September | 46 | 34 | 80 |
| 2019 August | 52 | 22 | 74 |
| 2019 July | 43 | 15 | 58 |
| 2019 June | 82 | 17 | 99 |
| 2019 May | 123 | 39 | 162 |
| 2019 April | 59 | 24 | 83 |
| 2019 March | 32 | 24 | 56 |
| 2019 February | 40 | 29 | 69 |
| 2019 January | 40 | 25 | 65 |
| 2018 December | 38 | 19 | 57 |
| 2018 November | 55 | 33 | 88 |
| 2018 October | 168 | 49 | 217 |
| 2018 September | 32 | 21 | 53 |
| 2018 August | 19 | 12 | 31 |
| 2018 July | 12 | 7 | 19 |
| 2018 June | 12 | 18 | 30 |
Show all
